Revisional Cosmetic Breast Surgery: The use of Acellular Dermal Matrices (ADMs)
Breast Augmentation is one of the most common aesthetic surgeries Plastic Surgeons perform. While breast augmentation is a very safe and reliable proceedure, patients can require revisional surgeries over the many years they have implants. Some revisions may be needed due to aging of the breast tissues, breast feeding, weight changes,rippling, broken implants, capsule formation around the implant, or malposition of the original implant. It has become more frequent to use acellular dermal matrices (ADMs) to correct some of these breast issues. What is an ADM exactly? The tissues that make up skin are very strong and dermis is the main strength component of skin. Some ADMs come from human sources and some are porcine (pig) skin derived. Pig skin is biochemically and structurally very similar to human skin. The cells are all removed from the collagen and other components that make up the dermis. This leaves a sheet that can be placed in the body and used to reinforce weak tissue in the breast. These sheets of dermis can help resolve ripping in the breast, reinforce areas where the weight of an implant over time has stretched out breast tissue, or improve control of implants that might be too medially placed (symmastia).
If a patient has very little native breast tissue and over the years forms a thick capsule around an implant we may need to remove all of that capsular scar tissue which may now leave weakened thin breast tissue that had been a bit stretched by the implants over the years. This patients may benefit from the addition of an ADM to give thicker coverage and better internal support to the implant. Multiple manufactures market ADMs and there is no consensus that one is superior than another. These products come in different thicknesses and sizes also so the surgeon will decide what type or thickness of product they prefer. We continue to look scientifically at these dermal products to see if some hold up better than others and try to balance the benefits against the cost or any down sides to the products.
Of course, the cost of ADMs is a significant concern to our patients so they are not necessarily indicated for all patients. Many revisional breast surgeries, if not most, do not require ADMs to fix the problem. That being said however, if a patient has had a revision failure for the same problem it is more likely that an ADM will be suggested or required to fix the issue. The added expense of the ADM product may be well worth it in those cases. As we refine the science of these products maybe someday we can have a readily available one generated by a 3-dimensional biologic printer for nominal expense to our patients. Now that would be fabulous, let’s hope the future is not to far off. For now we will use the best science we have on hand to assist patients with there breast surgery needs.